The Impact of Obesity on Short- and Long-term Outcomes After Lumbar Fusion

Ramos, Rafael De la Garza; Bydon, Mohamad; Abt, Nicholas B.; Sciubba, Daniel M.; Wolinsky, Jean Paul; Bydon, Ali; Gokaslan, Ziya L.; Rabin, Bruce A.; Witham, Timothy F.

doi:10.1097/brs.0000000000000655

Cited by 117 publications

(80 citation statements)

References 21 publications

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“…Medical comorbidities, 44 increased body mass index, 6,18 and revision surgery 39 have all been associated with increased surgical and medical complications in patients undergoing spine surgery, with minimally invasive spinal fusion being increasingly applied in these high-risk patients. 19,34,45 Although we were unable to examine for differences due to lack of reporting of specific predictor variables in the majority of studies, we do not believe it likely that this would have significantly influenced our results.…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

Goldstein¹,

Macwan

Sundararajan

et al. 2016

SPI

218

128

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OBJECT The objective of this study was to determine the clinical comparative effectiveness and adverse event rates of posterior minimally invasive surgery (MIS) compared with open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). METHODS A systematic review of the Medline, EMBASE, PubMed, Web of Science, and Cochrane databases was performed. A hand search of reference lists was conducted. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) or comparative cohort studies including at least 10 patients undergoing MIS or open TLIF/PLIF for degenerative lumbar spinal disorders and reporting at least 1 of the following: clinical outcome measure, perioperative clinical or process measure, radiographic outcome, or adverse events. Study quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. When appropriate, a meta-analysis of outcomes data was conducted. RESULTS The systematic review and reference list search identified 3301 articles, with 26 meeting study inclusion criteria. All studies, including 1 RCT, were of low or very low quality. No significant difference regarding age, sex, surgical levels, or diagnosis was identified between the 2 cohorts (856 patients in the MIS cohort, 806 patients in the open cohort). The meta-analysis revealed changes in the perioperative outcomes of mean estimated blood loss, time to ambulation, and length of stay favoring an MIS approach by 260 ml (p < 0.00001), 3.5 days (p = 0.0006), and 2.9 days (p < 0.00001), respectively. Operative time was not significantly different between the surgical techniques (p = 0.78). There was no significant difference in surgical adverse events (p = 0.97), but MIS cases were significantly less likely to experience medical adverse events (risk ratio [MIS vs open] = 0.39, 95% confidence interval 0.23–0.69, p = 0.001). No difference in nonunion (p = 0.97) or reoperation rates (p = 0.97) was observed. Mean Oswestry Disability Index scores were slightly better in the patients undergoing MIS (n = 346) versus open TLIF/PLIF (n = 346) at a median follow-up time of 24 months (mean difference [MIS – open] = 3.32, p = 0.001). CONCLUSIONS The result of this quantitative systematic review of clinical comparative effectiveness research examining MIS versus open TLIF/PLIF for degenerative lumbar pathology suggests equipoise in patient-reported clinical outcomes. Furthermore, a meta-analysis of adverse event data suggests equivalent rates of surgical complications with lower rates of medical complications in patients undergoing minimally invasive TLIF/PLIF compared with open surgery. The quality of the current comparative evidence is low to very low, with significant inherent bias.

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Section: Discussionmentioning

confidence: 99%

Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

Goldstein¹,

Macwan

Sundararajan

et al. 2016

SPI

218

128

View full text Add to dashboard Cite

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“…For example, in cervical fusion surgery, obesity was linked to urinary tract infection, wound dehiscence, and neck hematoma, 93 whereas in lumbar fusion surgery obese patients associated with increased blood loss, length of hospital stay, risk of postoperative complication, and surgical site infection. 94 Further, there are limitations to the utility of BMI for evaluating obesity. For instance in athletic muscular individuals, higher BMI may not necessarily correspond to increased adiposity or obesity.…”

Section: Discussionmentioning

confidence: 99%

Obesity Is an Independent Risk Factor of Early Complications After Revision Spine Surgery

Sing

Yue

Metz

et al. 2016

SPINE

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“…12 Several reports suggest that obesity may have an adverse impact on clinical outcomes following spinal fusion surgery. 7,8,11 However, the impact of surgery itself on weight changes in obese patients is unknown. In this retrospective cohort study, we aimed to address whether symptomatic relief following TLIF was associated with weight loss, as measured by BMI.…”

Section: Discussionmentioning

confidence: 99%

Does clinical improvement of symptomatic degenerative lumbar disease impact obesity?

Joseph¹,

Farooqui²,

Smith³

et al. 2017

SPI

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OBJECTIVEObesity and low-back pain associated with degenerative spondylosis or spondylolisthesis are common comorbid conditions. Many patients report that the pain and disability associated with degenerative lumbar disease are key factors in their inability to lose weight. The aim of this retrospective study was to determine if there is an association between improved functional status and weight loss following a successful transforaminal lumbar interbody fusion (TLIF) procedure.METHODSA retrospective cohort study of patients who underwent single-level TLIF was performed. Inclusion criteria were preoperative body mass index (BMI) greater than 30 kg/m2, achievement of minimum clinically important difference in the Oswestry Disability Index (ODI, defined as improvement of 15 points), and minimum 1-year postoperative followup BMI. Preoperative and postoperative BMI, ODI, and visual analog scale (VAS) scores were compared. A subgroup analysis of patients who achieved substantial clinical benefit (SCB, defined as a net improvement of 18.8 points on the ODI) was also performed.RESULTSA total of 56 patients met the inclusion criteria. The mean age of the study population was 55.6 ± 13.7 years. The mean preoperative BMI was 34.8 ± 4.6 kg/m2, the mean preoperative ODI was 66.2 ± 10.1, and the mean preoperative VAS score was 7.1 ± 1.7. The mean change in ODI was −33.1 ± 13.5 (p < 0.01) and the mean change in the VAS score was −4.1 ± 2.1 (p < 0.01). The mean change in BMI was +0.15 ± 2.1 kg/m2 (range −4.2 to +6.5 kg/m2; p = 0.6). SCB was achieved in 46 patients on the ODI. The mean preoperative BMI for patients with SCB was 34.8 ± 4.8 kg/m2, and the mean postoperative BMI was 34.7 ± 5.0 kg/m2. The mean change in BMI was −0.03 ± 1.9 kg/m2 (p = 0.9).CONCLUSIONSDespite successful surgical intervention via TLIF with achievement of improved function and pain, obese patients did not have significant change in weight postoperatively.

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The Impact of Obesity on Short- and Long-term Outcomes After Lumbar Fusion

Cited by 117 publications

References 21 publications

Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

Obesity Is an Independent Risk Factor of Early Complications After Revision Spine Surgery

Does clinical improvement of symptomatic degenerative lumbar disease impact obesity?

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